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Sex differences in how older students influence younger student smoking behaviour.

The purpose of this study was to examine sex differences in how the smoking behaviour of close friends and older peers at school influence smoking onset and progression among 10,843 grade 9, 10 and 11 students from 29 secondary schools in Ontario, Canada. In lower-risk student populations (i.e., students with no smoking friends or one smoking friend), males and females were both at a similar level of risk for occasional smoking as a function of the smoking rate of older students at their school. Among higher-risk student populations (i.e., students with three or more close friends who smoke), the smoking rate of older students at school did not influence the risk of occasional smoking. The odds of a female student being a regular smoker increased as the prevalence of smoking among older students at her school increased regardless of her close friends' smoking behaviour. However, among male students, the influence of older student smoking at school on the odds of regular smoking was moderated by the number of close friends who smoke. It appears that the prevalence of older student smoking at a school is more influential among younger female students, whereas the smoking behaviour of close friends appears to be more influential among younger male students. This new finding provides unique insight for tailoring and targeting future school-based smoking prevention initiatives.

Adolescent↗

The impact of aeromedical response to patients with moderate to severe traumatic brain injury.

STUDY OBJECTIVE: Aeromedical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control for the effect of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. METHODS: This was a retrospective analysis using our county trauma registry. All patients with head Abbreviated Injury Score of 3 or greater were included; interfacility transfers were excluded. The impact of aeromedical response was determined using logistic regression, adjusting for age, sex, mechanism, preadmission Glasgow Coma Scale score, head Abbreviated Injury Score, Injury Severity Score, and the presence of preadmission hypotension. Propensity scores were used to account for variability in selection of patients to undergo air versus ground transport. Patients with moderate and severe traumatic brain injury, as defined by head Abbreviated Injury Score and Glasgow Coma Scale score, were compared. Finally, aeromedical patients undergoing field intubation were compared with ground patients undergoing emergency department (ED) intubation. RESULTS: A total of 10,314 patients meeting all inclusion and exclusion criteria and with complete data sets were identified and included 3,017 transported by aeromedical crews. Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes were significantly better for the aeromedical patients when adjusted for age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR] 1.90; 95% confidence interval [CI] 1.60 to 2.25; P<.0001). Good outcomes (discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36; 95% CI 1.18 to 1.58; P<.0001). The primary benefit appeared to be in more severely injured patients, as reflected by head Abbreviated Injury Score and Glasgow Coma Scale score. Improved survival was also observed for air-transported patients intubated in the field versus ground-transported patients given emergency intubation in the ED (adjusted OR 1.42; 95% CI 1.13 to 1.78; P<.001). CONCLUSION: Here we analyze a large database of patients with moderate to severe traumatic brain injury. Aeromedical response appears to result in improved outcomes after adjustment for multiple influential factors in patients with moderate to severe traumatic brain injury. In addition, out-of-hospital intubation among air-transported patients resulted in better outcomes than ED intubation among ground-transported patients. Patients with more severe injuries appeared to derive the greatest benefit from aeromedical transport.

Abbreviated Injury Scale↗

Comparison of RBCA and CalTOX for setting risk-based cleanup levels based on inhalation exposure.

Risk-based corrective action (RBCA) and CalTOX (California EPA) are often used to develop risk-based soil cleanup levels. The determination of the entry parameters, including slope factors, degradation assumption, methodologies, and dispersion models for these two approaches greatly affect the onsite/offsite cleanup levels, risk distribution, and ranking of the influential factors. The subsurface soil-to-ambient air was considered as the only significant exposure pathway in this study. RBCA and CalTOX apply analytical equations and multimedia fugacity model, respectively, to simulate the transport of contaminants from subsurface soil to ambient air. Nine carcinogenic organic contaminants were selected as the target compounds. Environmental monitoring data collected from a contaminated site in southern Taiwan was used as model inputs. In this study, degradation assumption had greater influence on CalTOX evaluation than slope factors. The cleanup soil levels of all target chemicals developed by both models were close under the same slope factors and degradation assumptions, except for vinyl chloride and hexachlorobenzene. Furthermore, RBCA generally had larger offsite dispersion ratios than CalTOX, especially for long distances. The risk distribution obtained by RBCA was much board than by CalTOX. When 95th percentile was considered as the starting point, the SSTLs derived by RBCA were much stricter than by CalTOX. The ranking of influential factors in the onsite risk assessment for these two models were completely different because of their distinct model methodologies.

Body Weight↗

Lessons from the organization of a proficiency testing program in food microbiology by interlaboratory comparison: analytical methods in use, impact of methods on bacterial counts and measurement uncertainty of bacterial counts.

The proficiency testing program in food microbiology RAEMA (Réseau d'Analyses et d'Echanges en Microbiologie des Aliments), created in 1988, currently includes 450 participating laboratories. This interlaboratory comparison establishes proficiency in detection of Salmonella and Listeria monocytogenes, as well as enumeration of aerobic micro-organisms, Enterobacteriaceae, coliforms, beta-glucuronidase-positive Escherichia coli, anaerobic sulfito-reducing bacteria, Clostridium perfringens, coagulase-positive staphylococci, and L. monocytogenes. Twice a year, five units samples are sent to participants to assess their precision and trueness for enumeration and detection of micro-organisms. Most of participating laboratories use standard or validated alternative methods, they were 50-70% in 1994 and, for 5 years, they are 95%. An increasing use of alternative methods was also observed. This phenomenon is all the more significant as standard methods are laborious and time consuming; thus, 50% of the laboratories use alternative methods for the detection of Salmonella and L. monocytogenes. More and more laboratories use ready-to-use media and although the percentage is variable according to the microflora, we can consider that, today, 50-60% of the laboratories participating to the proficiency program only use ready-to-use media. The internal quality assurance programs lead also to an increasing use of media quality controls. The impact of analytical methods on bacterial counts was assessed by grouping together the results obtained by participating laboratories during the 10 last testing schemes from 1999 to 2003. The identified significant factors influencing enumeration results are variable from one microflora to another. Some of them significantly influence many microflora: the plating method (spiral plating or not) is influential for aerobic micro-organisms, Enterobacteriaceae, coliforms, and staphylococci, the type of culture medium and the medium manufacturer is influential for aerobic micro-organisms, Enterobacteriaceae, coliforms, E. coli, anaerobic sulfito-reducing bacteria, staphylococci, and L. monocytogenes. Others are specific of some micro-organisms: the resuscitation broth for L. monocytogenes, the mode of medium preparation for staphylococci and the incubation temperature for C. perfringens. These effects lead generally to small differences of about 0.1 log10 cfu g(-1), except for the enumeration of anaerobic sulfito-reducing bacteria, where the difference reaches 0.7 log10 cfu g(-1). These results, although difficult to extrapolate to all actual situations, which associate numerous food constituents and physiological states of bacteria to detect or numerate, allow nevertheless the quantification of interlaboratory variations linked to the methods in use. The analysis of bacterial counts obtained by the laboratories participating to the RAEMA proficiency testing program allowed also to validate a formula to calculate the repeatability of bacterial counts and to estimate the between-laboratory uncertainties for the majority of micro-organisms enumerated in food microbiology. The repeatability uncertainty is only indirectly affected by the method in use but depends essentially on the number of counted colonies. On the other hand, the between-laboratory uncertainty varies with the enumeration method in use, this variability is relatively small for the enumerations calling for methods without colony confirmation, i.e. for the enumeration of aerobic micro-organisms, Enterobacteriaceae, 'total' and thermotolerant coliforms, beta-glucuronidase-positive E. coli and coagulase-positive staphylococci with the technique using the rabbit-plasma fibrinogen agar. For these methods, the average between-laboratory standard deviation is 0.17 log10 cfu g(-1). The between-laboratory uncertainty is, on the contrary, larger for more complex techniques. For the enumeration of coagulase-positive staphylococci with the Baird-Parker agar, the between-laboratory standard deviation is equal to 0.23 log10 cfu g(-1), it is equal to 0.28 log10 cfu g(-1) for the enumeration of L. monocytogenes, to 0.34 log10 cfu g(-1) for the enumeration of C. perfringens, and to 0.47 log10 cfu g(-1) for the enumeration of anaerobic sulfito-reducing bacteria.

Bacteria↗

Factors influencing the contamination of UK banknotes with drugs of abuse.

Bank of England banknotes sampled from different locations in the UK have been analysed for the presence of cocaine, diamorphine (DAM), Delta(9)-tetrahydrocannabinol (THC) and 3,4-methylenedioxymethamphetamine (MDMA). A database of the contamination detected is routinely used as a benchmark against which the contamination detected on seized banknotes can be compared. Evidence presented at court details how banknotes seized from a suspect may differ from banknotes in general circulation in terms of their contamination with controlled drugs. A question arising from such evidence is whether seized banknotes could have become contaminated through being in circulation in drug "hot spots". In order to address this issue, a Plackett-Burman experimental design was used to investigate the influence of source location and other factors on banknote contamination with drugs of abuse. Banknotes were drawn from banks in eight regions throughout the UK. Each location could be described by a unique combination of the factors under investigation, namely whether the location was rural or urban, in the North or South of the UK, and whether it was a port of entry. The socio-economic class and the proportion of drug offenders in the area and the denomination of the banknotes were also considered as potentially influential factors. Indices were calculated to describe the degree to which samples were contaminated with different drugs, and normal probability plots were used to identify the factors that could account for the contamination observed. Whilst some factors were more influential than others, it was shown that, at the 95% confidence level, none of the proposed factors were significant influences on the contamination. Cocaine contamination on banknotes has been shown to follow a log-normal distribution. It was, therefore, possible to calculate F- and t-statistics to compare the cocaine contamination on the entire sample set with that detected on a second sample set consisting of banknotes all drawn from a single bank branch. It was shown that both inter-bank samples and intra-bank samples had similar variance and similar contamination levels at the 95% confidence level. This suggests that there are no significant regional trends in the contamination of banknotes with drugs of abuse across the UK.

Journal Article↗

Health practitioners' and health planners' information needs and seeking behavior for decision making in Uganda.

BACKGROUND: Access to reliable information is the most cost-effective and achievable strategy for sustainable improvement in health care. While several studies have described practitioners' information seeking behavior in developed countries, literature from developing countries is lacking. The aims of the study were: (i) to determine the most influential type of information for health workers' and planners' decision making; (ii) to establish the practitioners' evaluation of the availability and quality of this important information; and (iii) to establish the most commonly used/accessible sources of the information relevant for decision making in Uganda. METHODS: Self-administered questionnaires were sent to 610 health workers, planners, and administrators at the national, district and health facility levels in four districts in Uganda. Respondents were reminded three times, after which non-response was registered. Data were entered, cleaned and analysed using SPSS version 12.0. Logistic regression analysis was used to test for differences in responses. RESULTS: The response rate was 67.7% (413). The respondents indicated that personal experience (79%), discussion with colleagues (76%) and national policy and treatment guidelines (75%) were most influential when making decisions in health care and planning. They reported that most of the epidemiological information was available and of relatively good quality but there was lack of information about distribution of benefit, segregated demographic data, and social values. The most often used sources of information included; discussions with colleagues (89%), doctors' statements (85%) and text books (77%). The least frequently used sources were the internet and the library. This varied with respondents' designation and region of origin. CONCLUSIONS: Health planners and practitioners lack some of the information relevant for decision making. They tend to rely on the national policy and treatment guidelines, discussion with colleagues, and personal experience. Most frequently used sources of information are similar to previous studies. The variation in the frequency of use of the different sources of research information necessitates research to understand the barriers and careful planning of health information delivery to ensure equitable access.

Access to Information↗

Effect of ambient conditions on simultaneous growth and bioaccumulation of mercuric ion by genetically engineered E. coli JM109.

Genetically engineered E. coli JM109, namely M1, which expressed both Hg(2+) transport system and metallothionein, was tested for its capability of simultaneous growth and bioaccumulation of Hg(2+) under low nutritional circumstances. The influential factors of ambient conditions, e.g. initial concentrations of mercuric ion, ionic strength, the presence of metal chelators and other coexisting metal ions were investigated. Hg(2+) bioaccumulation behavior of M1 proved to be well coupled with its growth. NaCl was essential to the growth of M1. Of all tested NaCl concentrations, 0.04 mol/L was optimal. The presence of 0.1 mol/L CaCl(2) or MgCl(2) could promote the growth of M1 and keep the Hg(2+) removal ratio high, but the growth of M1 was inhibited seriously as the concentration of CaCl(2) or MgCl(2) reached 0.3 mol/L. Chelator EDTA had a significant influence on M1 growth and Hg(2+) bioaccumulation, while the effect of citration was little. The presence of other coexisting metal ions inhibited the growth of M1. The influential order was as follows: Cd(2+)>Zn(2+)> or =Cu(2+)>Pb(2+)>Ni(2+). However, only Cd(2+) and Cu(2+) posed obviously adverse effects on Hg(2+) bioaccumulation during the SG&B process.

Chelating Agents↗

Why do students choose careers in surgery?

BACKGROUND: Recent changes in medical education have emphasized primary care careers. This could have a negative impact on the number of applicants to surgical residencies. We hypothesized that experiences during the third year surgical clerkship are influential for students' subsequent residency choice. MATERIALS AND METHODS: Third year medical students who completed their surgical clerkship in the 2001-02 academic year were surveyed pre- and post-surgical clerkship. Responses were analyzed and correlated to the 2003 match results. RESULTS: The response rate of students surveyed was 98% (82 surveys/83 match results). Pre-clerkship, 6/82 students (7%) expressed an interest in surgery or surgical subspecialty careers. Post-clerkship, 34/84 students (40%) expressed an increased interest a surgical career; 13/84 (15%) expressed a decreased interest, and 37% of students expressed no change in career interest. Of those students expressing an increased interest in surgery, the clerkship experiences most noted to be influential were (1) number of cases participated/scrubbed (95%), (2) resident interaction (85%), (3) faculty interaction (80%), and (4) number of cases observed (65%). The number of hours spent on rotation (call, rounds) was the leading experience associated with a decreased interest in a surgical career. 12/83 students surveyed (14%) ultimately matched into a surgical program (NRMP 2003 match results). CONCLUSIONS: These data suggest that operative exposure and interaction with residents and faculty have a positive influence in students' choice of a surgical career. Although only 6% of students expressed an interest in surgery pre-clerkship, a 2-fold increase in this number was noted in choice of residency (14%). Work hours were the primary negative indicator for surgery residency. As medical curriculum is restructured and surgical exposure decreased, these data underscore the importance of quality exposure to both procedures and role models during the 3rd year surgical clerkship.

Career Choice↗

Beyond emotion archetypes: databases for emotion modelling using neural networks.

There has been rapid development in conceptions of the kind of database that is needed for emotion research. Familiar archetypes are still influential, but the state of the art has moved beyond them. There is concern to capture emotion as it occurs in action and interaction ('pervasive emotion') as well as in short episodes dominated by emotion, and therefore in a range of contexts, which shape the way it is expressed. Context links to modality-different contexts favour different modalities. The strategy of using acted data is not suited to those aims, and has been supplemented by work on both fully natural emotion and emotion induced by various technique that allow more controlled records. Applications for that kind of work go far beyond the 'trouble shooting' that has been the focus for application: 'really natural language processing' is a key goal. The descriptions included in such a database ideally cover quality, emotional content, emotion-related signals and signs, and context. Several schemes are emerging as candidates for describing pervasive emotion. The major contemporary databases are listed, emphasising those which are naturalistic or induced, multimodal, and influential.

Computer Simulation↗

Adoption of hospital case management: economic and institutional influences.

Case management became prevalent in US hospitals in the 1990s and is believed to be beneficial in controlling resource utilization, improving quality of care, reducing variation of care processes and enhancing both patient and staff satisfaction. This research investigates the adoption of case management by US hospitals at three time periods: 1994, 1997, and 2000. We propose that both economic and institutional factors influence the adoption of this management innovation, with economic factors being more influential in early and mid-periods (1994-1997) and institutional factors being more influential in later periods (after 1997). Using American Hospital Association Annual Survey Data and community data from the Area Resources File, we assess the relationship of baseline (1994) hospital and market characteristics to the likelihood of early adoption compared to late adoption, and mid-adoption compared to late adoption. We confirm that both economic and institutional forces influence the likelihood of early and mid-period adoption of case management compared to late adoption. We conclude that institutional influences aimed at achieving or maintaining legitimacy may be as strong a motivator for hospitals to adopt case management as are economic incentives. Implications for practice and further research are discussed.

Case Management↗

Senior student smoking at school, student characteristics, and smoking onset among junior students: a multilevel analysis.

BACKGROUND: Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset. METHOD: Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project. RESULTS: Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03-1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified. CONCLUSIONS: The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.

Adolescent↗

Maternal mortality rates in eclampsia.

This study evaluates the dominant factors that influence the course of eclampsia toward a lethal outcome by means of statistical analysis of various clinical, laboratory, and morphologic data of 365 cases of toxemia with convulsions, that included 49 deaths and 33 autopsies, registered during a 9 year period. This communication suggests that the death of eclamptic patients resulted from a combination of several factors that showed a very wide individual variation. Since advancing age of the mother was associated with a high incidence of coincidental renal and vascular diseases, this was the most clearly influential factor. The presence of twins, delay in hospitalization, under haste in deciding upon cesarean delivery, and underestimation of the initial clinical condition were all influential factors, although without statistical significance. Cesarean section, performed in 141 instances of ante- and intrapartum eclasmpsia (40.4 per cent), was not associated with a higher maternal mortality rate.

Adolescent↗

Tropic responses of Funaria spores to red light.

The tropic responses of Funaria hygrometrica spores to continuous illumination with red light (610 to 690 mmu) have been studied over the intensity range from 10(-5) through 10(+6) erg/cm(2) second, using both plane polarized light and partial illumination with unpolarized light. From the relative frequency of outgrowth origin in different directions, the following is inferred. (1). The germination direction of chloronemal filaments is directly influenced by red light over this whole intensity range, while that of rhizoids tends to be opposite the chloronema. (2) Three photoreceptor systems direct chloronemal primordia: (a) A low intensity system acting from 10(-5) to 10(-0.5) erg/cm(2) second. It favors their growth from a cell's brightest part(s). Its photoreceptors are disoriented, excited by the electric vector, and probably are dispersed phytochrome molecules. (b) A medium intensity system which acts largely alone only at 10(0.5) erg/cm(2) second but is influential from 10(0) to 10(5) erg/cm(2) second. It likewise favors growth from a cell's brightest part(s); its receptor molecules are also excited electrically, but they are tangentially oriented. (c) A high intensity system which acts alone from 10(5) to 10(6) erg/cm(2) second and is influential down to 10(1) erg/cm(2) second. It favors growth of the chloronemas from a cell's darkest part. Its receptors probably are magnetically excited and tangentially oriented. The polarotropic responses of the chloronemas resemble those directing their origins. One new feature is that under intense (10(6) erg/cm(2) second) plane polarized and vertically directed light, many soon grow to form tight helices.

Biophysical Phenomena↗

Decision making in patients with spinal cord damage: afferent feedback and the somatic marker hypothesis.

Damasio has proposed an influential model of human decision making - the somatic marker hypothesis (Damasio AR. Descates' Error. London: Papermac/Macmillan, 1994), where he argues that somatic feedback to the brain influences decision making in man. It is proposed that when choosing between options that differ in relative risk, a somatic marker (e.g. a 'gut feeling') feeds back to the brain and influences cognitive appraisal. In the present study patients who had suffered a complete tetraplegia at the level of the sixth cervical vertebra were compared with matched healthy control subjects. As the spinal injury group have reduced somatic/peripheral feedback via the spinal cord, it was predicted, based on the somatic marker hypothesis, that they may demonstrate riskier behaviour than controls. All subjects completed the Iowa Gambling Task, a computerised card playing game where the player is instructed to try and win as much money as possible over 100 selections from one of four decks. The rules are not disclosed in advance, and the player gradually 'learns' that two of the decks are 'high risk' and lead to significant financial losses. Healthy individuals have previously been shown to learn to avoid the risky decks, whereas patients with medial frontal lobe damage (Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994;50:7-15) and those with peripheral neuropathy (Bechara A, Tranel D, Wilson J, Heberlein AS, Ross M, Damasio AR, 1998. Impaired decision-making in peripheral neuropathy. Society for Neuroscience Abstracts 24:1176) select an excessive number from the risky decks, and consequently lose money. In the present study there were no significant differences between the spinal sectioned and healthy control groups in either card selection strategy or net financial outcome. This result suggests that in terms of the somatic marker hypothesis, feedback to the brain from the periphery via the cranial vagus and other nerves and the hormonal route may be equally or more influential than afferent feedback transmitted via the spinal cord.

Adult↗

Palatability and intake relationships in free-living humans. characterization and independence of influence in North Americans.

In order to investigate palatability influences on the ad lib eating behavior of free-living humans, 564 participants were paid to maintain food intake diaries for 7 days. They recorded their intake along with a global rating of the palatability of the entire meal on a seven-point scale. It was found that most meals that are self-selected are palatable and that only 9.3% are rated as unpalatable. Meals that were highest in palatability were 44% larger than meals that were low in palatability, but palatability only accounted for around 4% of the variance in meal sizes. Multiple regression demonstrated that palatability appears to act on intake independent of the levels of other influential factors. These results were very similar to those observed for the French and suggest that palatability operates similarly on intake regardless of culture. Palatability appears to be an influence on the amounts ingested by free-living humans in their natural environments but appears to be only one of many influential factors and accounts for only a small proportion of the variance in intake.

Adolescent↗

Maize and foxtail millet as substantial sources of dietary lead intake.

In 1996, 24-h food duplicate samples were collected from two groups of 50 non-smoking women each; one group was in Jinan, the capital city of Shandong Province in China, and the other in a farming village in the Zhangqiu area some 30 km away from the city. The people in the village took significantly more dietary lead (46 micrograms/day) than their counterparts in the city (26 micrograms/day), and blood lead concentrations (35 and 50 micrograms/l for the urban and the rural people, respectively) were in parallel with the dietary lead intake. Search for cereals as the determinants of dietary lead intake and blood lead concentration by multiple regression analysis showed that maize was the most influential source of dietary lead intake among the four common cereals of wheat, rice, foxtail millet (to be called just millet) and maize, whereas millet was the leading determinant of the blood lead level among the four cereals although the influential power was weaker than millet for dietary lead. Lead content in maize (47 ng/g) and millet (47 ng/g) was twice or even more times higher than the levels in wheat (26-30 ng/g) and rice (20-21 ng/g). The significant roles of non-rice/non-wheat cereals such as millet and maize as possible dietary lead sources for farming populations are discussed.

Adult↗

Increasing the clinical yield of computerized tomography for psychiatric patients.

Computerized tomography (CT) continues to be extensively utilized to exclude intracranial pathology in psychiatric practice, but little is known about clinical risk factors, which might predict those patients most likely to benefit from the procedure. We reviewed 150 cases of psychiatric patients who received CT scans to exclude intracranial pathology. We assessed the relationships of patient age, psychiatric diagnosis, and findings from neurologic and cognitive examinations to CT results that influenced patient care, and overall normal and abnormal CT results. Fifty-three percent of the CT scans were abnormal, 11% influenced patient care, and only 2% identified potentially reversible lesions. Cognitive exam results and, to a lesser extent, neurologic exam results, were sensitive predictors of CT findings that influenced patient care. All patients with clinically influential CT results had cognitive deficits and all but one had neurologic deficits. Patients older than 60 years of age and those with organic mental syndromes were most likely to have clinically influential CT findings. Our results suggest that utilizing specific clinical risk factors such as findings from clinical examinations, patient age, and psychiatric diagnosis, to guide the ordering of CT scans, can greatly increase the yield of the procedure for psychiatric patients, without excess medical morbidity.

Adult↗

Culling of dairy cows. Part III. Effects of diseases, pregnancy status and milk yield on culling in Finnish Ayrshire cows.

The effects of 15 diseases, pregnancy status and milk yield on culling were studied in 39727 Finnish Ayrshire cows that calved in 1993 and were followed until culling or next calving. Survival analysis, using the Cox proportional hazards model, was performed with diseases, pregnancy status and milk yield as time-dependent covariates. Effects of parity, calving season and herd were also accounted for. Pregnancy status was the single most influential factor affecting culling decisions, followed by milk yield. Several diseases also had a significant effect on culling, the most influential ones being mastitis, lameness, teat injuries, and milk fever. The effects of all of these factors varied according to the stage of lactation. Milk yield had a significant effect on culling decisions, depending on the stage of lactation. At the beginning of lactation, milk production did not have any effect on culling decisions, but later on, the highest producers were at the lowest risk of being culled and the lowest producers had the highest risk. Adjusting for milk yield modified the effects of parity, most diseases and also pregnancy status on culling. Effects of parity increased after including milk yield in the model, indicating that milk yield and parity are interrelated in their effects on culling. The effects of pregnancy status also increased towards the end of lactation when milk yield was accounted for in the model. The effects of mastitis, teat injuries and lameness decreased after adjusting for milk production. These diseases lower milk yield and thus, part of their effect on culling was mediated through milk production. The effects of anestrus and ovarian cysts were mainly modified by pregnancy status, but not by milk yield. The effects of milk fever on culling increased at the beginning of lactation after including milk yield in the model. This suggests that even though cows with milk fever tend to be higher producers, it is the disease as such that triggers the culling decision early in the lactation. The changes in the effects of other diseases after adjusting for milk yield varied, depending on the disease and the stage of lactation.

Animal Husbandry↗